The role of mean diffusivity (MD) as a predictive index of the response to chemotherapy in locally advanced breast cancer: a preliminary study.

OBJECTIVE: To evaluate the role of mean diffusivity (MD) as a predictive index of the response to chemotherapy in locally advanced breast cancer. METHODS: Twenty-one women referred to our institution with a diagnosis of locally advanced breast cancer underwent magnetic resonance imaging (MRI) studies at 1.5 T before beginning and after completing combined neoadjuvant chemotherapy. The examination protocol included an EPI sequence sensitised to diffusion (b-value 1,000 s/mm(2)) and three-dimensional (3D) coronal T1 sequences before and after intravenous contrast medium. Tumours were delineated by using dynamic MR acquisition before and after chemotherapy. The percentage of tumour volume reduction (PVR) and pre-(MD(pre)) and post-therapy (MD(post)) MD values were computed for each lesion. RESULTS: PVR >or= 65% was observed in 17/21 patients (responders). MD(pre) of responders (0.99 +/- 0.27 10(-3) mm(2)/s) was significantly (p = 0.025) lower than MD(pre) of non-responders (1.46 +/- 0.33 10(-3) mm(2)/s). Moreover, in patients as a whole PVR significantly correlated (p = 0.01, r = -0.54) with MD(pre). MD(post) (1.26 +/- 0.39 10(-3) mm(2)/s) of responders was significantly(p = 0.024) higher than MD(pre) (0.99 +/- 0.27 mm(2) 10(-3) mm(2)/s), whereas non-responders MD(post) (1.00 +/- 0.14 10(-3) mm(2)/s)did not increase compared with MD(pre) (1.46 +/- 0.33 10(-3) mm(2)/s). CONCLUSIONS: This preliminary study seems to indicate that low values of pre-chemotherapy MD may identify, before starting treatment, the patients with higher probability of response in terms of percentage of volume reduction of the lesion. MD may represent a complementary parameter useful to correctly select patients for neoadjuvant chemotherapy.

Triple-Negative versus Non-Triple-Negative Breast Cancers in High-Risk Women: Phenotype Features and Survival from the HIBCRIT-1 MRI-Including Screening Study.

PURPOSE: To compare phenotype features and survival of triple-negative breast cancers (TNBC) versus non-TNBCs detected during a multimodal annual screening of high-risk women. EXPERIMENTAL DESIGN: Analysis of data from asymptomatic high-risk women diagnosed with invasive breast cancer during the HIBCRIT-1 study with median 9.7-year follow-up. RESULTS: Of 501 enrolled women with BRCA1/2 mutation or strong family history (SFH), 44 were diagnosed with invasive breast cancers: 20 BRCA1 (45%), 9 BRCA2 (21%), 15 SFH (34%). Magnetic resonance imaging (MRI) sensitivity (90%) outperformed that of mammography (43%, P < 0.001) and ultrasonography (61%, P = 0.004). The 44 cases (41 screen-detected; 3 BRCA1-associated interval TNBCs) comprised 14 TNBCs (32%) and 30 non-TNBCs (68%), without significant differences for age at diagnosis, menopausal status, prophylactic oophorectomy, or previous breast cancer. Of 14 TNBC patients, 11 (79%) were BRCA1; of the 20 BRCA1 patients, 11 (55%) had TNBC; and of 15 SFH patients, 14 (93%) had non-TNBCs (P = 0.007). Invasive ductal carcinomas (IDC) were 86% for TNBCs versus 43% for non-TNBCs (P = 0.010), G3 IDCs 71% versus 23% (P = 0.006), size 16 ± 5 mm versus 12 ± 6 mm (P = 0.007). TNBC patients had more frequent ipsilateral mastectomy (79% vs. 43% for non-TNBCs, P = 0.050), contralateral prophylactic mastectomy (43% vs. 10%, P = 0.019), and adjuvant chemotherapy (100% vs. 44%, P < 0.001). The 5-year overall survival was 86% ± 9% for TNBCs versus 93% ± 5% (P = 0.946) for non-TNBCs; 5-year disease-free survival was 77% ± 12% versus 76% ± 8% (P = 0.216). CONCLUSIONS: In high-risk women, by combining an MRI-including annual screening with adequate treatment, the usual reported gap in outcome between TNBCs and non-TNBCs could be reduced.

Multicenter surveillance of women at high genetic breast cancer risk using mammography, ultrasonography, and contrast-enhanced magnetic resonance imaging (the high breast cancer risk italian 1 study): final results.

OBJECTIVES: : To prospectively compare clinical breast examination, mammography, ultrasonography, and contrast-enhanced magnetic resonance imaging (MRI) in a multicenter surveillance of high-risk women. MATERIALS AND METHODS: : We enrolled asymptomatic women aged ≥ 25: BRCA mutation carriers; first-degree relatives of BRCA mutation carriers, and women with strong family history of breast/ovarian cancer, including those with previous personal breast cancer. RESULTS: : A total of 18 centers enrolled 501 women and performed 1592 rounds (3.2 rounds/woman). Forty-nine screen-detected and 3 interval cancers were diagnosed: 44 invasive, 8 ductal carcinoma in situ; only 4 pT2 stage; 32 G3 grade. Of 39 patients explored for nodal status, 28 (72%) were negative. Incidence per year-woman resulted 3.3% overall, 2.1% <50, and 5.4% ≥ 50 years (P < 0.001), 4.3% in women with previous personal breast cancer and 2.5% in those without (P = 0.045). MRI was more sensitive (91%) than clinical breast examination (18%), mammography (50%), ultrasonography (52%), or mammography plus ultrasonography (63%) (P < 0.001). Specificity ranged 96% to 99%, positive predictive value 53% to 71%, positive likelihood ratio 24 to 52 (P not significant). MRI showed significantly better negative predictive value (99.6) and negative likelihood ratio (0.09) than those of the other modalities. At receiver operating characteristic analysis, the area under the curve of MRI (0.97) was significantly higher than that of mammography (0.83) or ultrasonography (0.82) and not significantly increased when MRI was combined with mammography and/or ultrasonography. Of 52 cancers, 16 (31%) were diagnosed only by MRI, 8 of 21 (38%) in women <50, and 8 of 31 (26%) in women ≥ 50 years of age. CONCLUSION: : MRI largely outperformed mammography, ultrasonography, and their combination for screening high-risk women below and over 50.

Multicenter comparative multimodality surveillance of women at genetic-familial high risk for breast cancer (HIBCRIT study): interim results.

PURPOSE: To prospectively compare clinical breast examination (CBE), mammography, ultrasonography (US), and contrast material-enhanced magnetic resonance (MR) imaging for screening women at genetic-familial high risk for breast cancer and report interim results, with pathologic findings as standard. MATERIALS AND METHODS: Institutional review board of each center approved the research; informed written consent was obtained. CBE, mammography, US, and MR imaging were performed for yearly screening of BRCA1 or BRCA2 mutation carriers, first-degree relatives of BRCA1 or BRCA2 mutation carriers, or women enrolled because of a strong family history of breast or ovarian cancer (three or more events in first- or second-degree relatives in either maternal or paternal line; these included breast cancer in women younger than 60 years, ovarian cancer at any age, and male breast cancer at any age). RESULTS: Two hundred seventy-eight women (mean age, 46 years +/- 12 [standard deviation]) were enrolled. Breast cancer was found in 11 of 278 women at first round and seven of 99 at second round (14 invasive, four intraductal; eight were

Differentiation of benign and malignant breast microcalcifications: mammography versus mammography-sonography combination.

PURPOSE: The aim of this study was to determine the diagnostic contribution of high-frequency sonography in the diagnosis of isolated clustered microcalcifications detected by mammography. MATERIAL AND METHODS: 238 women (aged 3198) with isolated clustered microcalcifications were examined by mammography and subsequently by high frequency sonography (13 MHz) at the site of microcalcification. 170 underwent surgery. 94 were affected by cancer and 76 by benign pathology. The other 68 were considered to have benign microcalcifications after three years follow-up. The ROC statistical technique was employed to compare the diagnostic role of mammography alone versus the combination of mammography and sonography. The area under the ROC curves was calculated by the Wilcoxon method, without any hypothesis on the distribution of the statistical data. RESULTS: The microcalcifications were neoplastic in 39.5% of cases. The difference between the areas under the mammography ROC curve (area = 0.807, standard error = 0.03) and the mammography-sonography ROC curve (area = 0.819, standard error = 0.028) was not statistically significant (p > 0.05). CONCLUSIONS: The higher sensitivity of mammography-sonography combination demonstrates that it may be useful to perform sonography following mammography when mammography yields a diagnosis of non malignant pathology.